Often dentists are faced with the dilemma of how much treatment should be done to retain a natural tooth or whether it should be removed and a prosthesis placed. A paper by Dr. Gustavo Avila et al (J. Periodontol 2009;80:476-490) helps to guide us from a clinical perspective. This course combines clinical thinking along with the patient's considerations in helping to make the critical decision as to whether to extract a tooth with a questionable prognosis or whether to retain it.